İsa Dağlı, Muhammed Zübeyr Canbolat, Tuncel Uzel, Abdullah Çayırlı, Mehmet Duvarcı, Erdem Öztürk
Objectives
Transperineal prostate biopsy (TP-Bx) is increasingly preferred due to its lower infection risk and improved clinically significant prostate cancer detection rates. Its feasibility under local anesthesia provides both clinical and economic advantages. However, acute urinary retention (AUR) remains a significant post-procedure concern. This study aims to evaluate the impact of transperineal prostate biopsy performed under local anesthesia on voiding function using uroflowmetry parameters.
Materials and Methods
A prospective observational study was conducted with 74 patients. TP-Bx was performed under local anesthesia using a freehand technique. Uroflowmetry parameters, including maximum urinary flow rate (Qmax, mL/s), average urinary flow rate (Qave, mL/s), voided volume (Vv, mL), and post-void residual volume (PVR), were assessed before and after the procedure to evaluate its impact on voiding function.
Results
The average changes in Qmax and Qave between pre and post procedure were 1.78 ± 4.33 and 0.63 ± 1.70, respectively. A significant reduction in Qmax and Qave was observed after TP-Bx (p < 0.001). PVR increased after TP-Bx (p < 0.001); however, these changes were mild and did not require catheterization.
Conclusion
With increasing experience, TP-Bx has become safer. The use of local anesthesia reduces anesthesia-related complications, and the historically feared risk of AUR appears lower than previously assumed. These findings support TP-Bx as a safe and effective diagnostic approach.
{"title":"Local Anesthetic Transperineal Prostate Biopsy: Does It Affect Uroflowmetry Results","authors":"İsa Dağlı, Muhammed Zübeyr Canbolat, Tuncel Uzel, Abdullah Çayırlı, Mehmet Duvarcı, Erdem Öztürk","doi":"10.1111/iju.70377","DOIUrl":"10.1111/iju.70377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Transperineal prostate biopsy (TP-Bx) is increasingly preferred due to its lower infection risk and improved clinically significant prostate cancer detection rates. Its feasibility under local anesthesia provides both clinical and economic advantages. However, acute urinary retention (AUR) remains a significant post-procedure concern. This study aims to evaluate the impact of transperineal prostate biopsy performed under local anesthesia on voiding function using uroflowmetry parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A prospective observational study was conducted with 74 patients. TP-Bx was performed under local anesthesia using a freehand technique. Uroflowmetry parameters, including maximum urinary flow rate (<i>Q</i><sub>max</sub>, mL/s), average urinary flow rate (<i>Q</i><sub>ave</sub>, mL/s), voided volume (<i>V</i><sub>v</sub>, mL), and post-void residual volume (PVR), were assessed before and after the procedure to evaluate its impact on voiding function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average changes in <i>Q</i><sub>max</sub> and <i>Q</i><sub>ave</sub> between pre and post procedure were 1.78 ± 4.33 and 0.63 ± 1.70, respectively. A significant reduction in <i>Q</i><sub>max</sub> and <i>Q</i><sub>ave</sub> was observed after TP-Bx (<i>p</i> < 0.001). PVR increased after TP-Bx (<i>p</i> < 0.001); however, these changes were mild and did not require catheterization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With increasing experience, TP-Bx has become safer. The use of local anesthesia reduces anesthesia-related complications, and the historically feared risk of AUR appears lower than previously assumed. These findings support TP-Bx as a safe and effective diagnostic approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The PEACE-3 trial demonstrated overall survival benefit for enzalutamide plus radium-223 versus enzalutamide alone in metastatic castration-resistant prostate cancer (mCRPC), but survival curves showed initial crossing followed by progressive separation, indicating non-proportional hazards. We aimed to characterize the time-dependent treatment effects through comprehensive analysis.
Methods
Individual patient datas (IPD) were reconstructed from published Kaplan–Meier curves of the PEACE-3 trial. Time-dependent treatment effects were evaluated by restricted mean survival time (RMST) analysis at predefined time points (18–72 months), time-dependent Cox regression with treatment-by-time interaction, piecewise Cox regression across 6 time intervals, landmark analyses, and Fleming-Harrington weighted log-rank tests.
Results
A total of 446 IPDs were reconstructed. Validation confirmed consistency with the original trial. During the initial 18 months, combination therapy showed no survival advantage (RMST difference: −0.36 months, 95% CI, −0.90 to 0.18, p = 0.20) and was associated with increased hazard (HR = 2.14, 95% CI, 1.48–3.10, p < 0.001). Significant survival benefits were observed after 60 months, with RMST differences of 4.34 months (95% CI, 0.49–8.19, p = 0.03) at 60 months and 6.25 months (95% CI, 1.56–10.95, p = 0.01) at 72 months. Time-dependent Cox regression confirmed a significant treatment-by-time interaction (p < 0.01). Piecewise analysis revealed the most substantial benefit for 60–72 months (HR = 0.20, 95% CI, 0.05–0.77, p = 0.02). Landmark analyses consistently demonstrated increasing treatment benefit with longer follow-up.
Conclusions
Enzalutamide plus radium-223 demonstrates delayed but substantial survival benefit in mCRPC, becoming statistically significant after 60 months with over 6 months survival advantage at 72 months.
Registry and the Registration No. of the Study/Trial
{"title":"Delayed Survival Benefit of Enzalutamide Plus Radium-223 in Metastatic Castration-Resistant Prostate Cancer: A Time-Dependent Analysis of Reconstructed Individual Patient Data From the PEACE-3 Trial","authors":"Wei Chen, Soichiro Yoshida, Shugo Yajima, Kenji Tanabe, Motohiro Fujiwara, Hiroshi Fukushima, Hajime Tanaka, Akihiro Hirakawa, Hitoshi Masuda, Yasuhisa Fujii","doi":"10.1111/iju.70376","DOIUrl":"10.1111/iju.70376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>The PEACE-3 trial demonstrated overall survival benefit for enzalutamide plus radium-223 versus enzalutamide alone in metastatic castration-resistant prostate cancer (mCRPC), but survival curves showed initial crossing followed by progressive separation, indicating non-proportional hazards. We aimed to characterize the time-dependent treatment effects through comprehensive analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individual patient datas (IPD) were reconstructed from published Kaplan–Meier curves of the PEACE-3 trial. Time-dependent treatment effects were evaluated by restricted mean survival time (RMST) analysis at predefined time points (18–72 months), time-dependent Cox regression with treatment-by-time interaction, piecewise Cox regression across 6 time intervals, landmark analyses, and Fleming-Harrington weighted log-rank tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 446 IPDs were reconstructed. Validation confirmed consistency with the original trial. During the initial 18 months, combination therapy showed no survival advantage (RMST difference: −0.36 months, 95% CI, −0.90 to 0.18, <i>p</i> = 0.20) and was associated with increased hazard (HR = 2.14, 95% CI, 1.48–3.10, <i>p</i> < 0.001). Significant survival benefits were observed after 60 months, with RMST differences of 4.34 months (95% CI, 0.49–8.19, <i>p</i> = 0.03) at 60 months and 6.25 months (95% CI, 1.56–10.95, <i>p</i> = 0.01) at 72 months. Time-dependent Cox regression confirmed a significant treatment-by-time interaction (<i>p</i> < 0.01). Piecewise analysis revealed the most substantial benefit for 60–72 months (HR = 0.20, 95% CI, 0.05–0.77, <i>p</i> = 0.02). Landmark analyses consistently demonstrated increasing treatment benefit with longer follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Enzalutamide plus radium-223 demonstrates delayed but substantial survival benefit in mCRPC, becoming statistically significant after 60 months with over 6 months survival advantage at 72 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Registry and the Registration No. of the Study/Trial</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Noninvasive Genotyping Test of Human Papillomavirus in Japanese Male Genital Warts by PCR From Scraping Specimens","authors":"Yu Yoshimura, Mamoru Hashimoto, Takahisa Genji, Kenji Nishimura, Masahisa Ikegami, Kazutoshi Fujita","doi":"10.1111/iju.70374","DOIUrl":"10.1111/iju.70374","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the safety and efficacy of mini-endoscopic combined intrarenal surgery (ECIRS) in older patients with renal and ureteral stones.
Methods
Consecutive patients with renal or ureteral stones who underwent mini-ECIRS were retrospectively analyzed at three Japanese tertiary care institutions between 2015 and 2021. Data on patient backgrounds, stone characteristics, and postoperative indications were collected and evaluated. After matching preoperative and intraoperative factors in older patients and other groups, postoperative factors were assessed using univariate analysis.
Results
The final analysis included data from 1303 single-session mini-ECIRS of 1432 cases collected. The patients were divided into two groups: those aged > 75 and those aged < 75 years, with 121 and 1182 patients. From each group, 112 cases matched for eight factors, performance status, body mass index, sex, hydronephrosis, percutaneous nephrostomy, pyuria, preoperative urinary tract infection, and preoperative ureteral stenting, were selected. The univariate analysis was performed on postoperative factors between the groups of matched older and matched non-older patients, and there was no significant difference in any factor, including postoperative hospitalization duration, complications, and stone-free rate (SFR).
Conclusions
To the best of our knowledge, this multicenter cohort study is the first to compare the efficacy and safety of the mini-ECIRS between older patients and other groups. It was discovered that surgery could be performed with a similar quality even in patients aged 75 and older compared to that in other groups.
{"title":"Outcomes of Mini-Endoscopic Combined Intrarenal Surgery in the Geriatric Population: A Matched-Pair Analysis","authors":"Takahiko Watanabe, Hiroki Ito, Tetsuo Fukuda, Fukashi Yamamichi, Yosuke Shibata, Tadashi Tabei, Kazuhide Makiyama, Takaaki Inoue, Junichi Matsuzaki, Kazuki Kobayashi","doi":"10.1111/iju.70372","DOIUrl":"10.1111/iju.70372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate the safety and efficacy of mini-endoscopic combined intrarenal surgery (ECIRS) in older patients with renal and ureteral stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with renal or ureteral stones who underwent mini-ECIRS were retrospectively analyzed at three Japanese tertiary care institutions between 2015 and 2021. Data on patient backgrounds, stone characteristics, and postoperative indications were collected and evaluated. After matching preoperative and intraoperative factors in older patients and other groups, postoperative factors were assessed using univariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final analysis included data from 1303 single-session mini-ECIRS of 1432 cases collected. The patients were divided into two groups: those aged > 75 and those aged < 75 years, with 121 and 1182 patients. From each group, 112 cases matched for eight factors, performance status, body mass index, sex, hydronephrosis, percutaneous nephrostomy, pyuria, preoperative urinary tract infection, and preoperative ureteral stenting, were selected. The univariate analysis was performed on postoperative factors between the groups of matched older and matched non-older patients, and there was no significant difference in any factor, including postoperative hospitalization duration, complications, and stone-free rate (SFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To the best of our knowledge, this multicenter cohort study is the first to compare the efficacy and safety of the mini-ECIRS between older patients and other groups. It was discovered that surgery could be performed with a similar quality even in patients aged 75 and older compared to that in other groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate-specific antigen (PSA) testing has long been central to prostate cancer detection but is limited by poor specificity, resulting in overdiagnosis and unnecessary prostate biopsies. Although PSA derivatives such as percentage free PSA and the Prostate Health Index (PHI) have improved diagnostic performance, substantial uncertainty persists, particularly in patients with equivocal magnetic resonance imaging (MRI) findings. Cancer-associated alterations in PSA glycosylation have emerged as a promising strategy to address these limitations. Percentage α2,3-linked sialylated PSA (S2,3PSA%) reflects tumor-associated glycoform changes that differ from those observed in benign prostatic conditions. This review summarizes the biological basis, analytical development, and clinical evidence supporting S2,3PSA% as a novel biomarker for prostate cancer diagnosis. We highlight key studies demonstrating that S2,3PSA% improves discrimination of clinically significant prostate cancer and provides complementary information when combined with PHI and MRI. Recent data further indicate that integrated diagnostic approaches incorporating S2,3PSA%, PHI, and PI-RADS scoring can meaningfully reduce unnecessary prostate biopsies without compromising detection of clinically significant disease. Beyond diagnostic accuracy, emerging evidence suggests that S2,3PSA%–guided risk stratification in screening settings may also reduce the number of unnecessary MRI examinations and biopsies, thereby contributing to more efficient use of healthcare resources and potential cost savings. We also discuss the potential role of S2,3PSA% in prostate cancer screening and active surveillance. Collectively, current evidence supports S2,3PSA% as a biologically informed biomarker that helps reduce diagnostic uncertainty inherent to PSA-based decision-making and facilitates more individualized and resource-conscious prostate cancer care.
{"title":"Beyond Total PSA: Clinical Significance of S2,3PSA% in Reducing Unnecessary Prostate Biopsies","authors":"Shingo Hatakeyama, Tohru Yoneyama, Chikara Ohyama","doi":"10.1111/iju.70371","DOIUrl":"10.1111/iju.70371","url":null,"abstract":"<p>Prostate-specific antigen (PSA) testing has long been central to prostate cancer detection but is limited by poor specificity, resulting in overdiagnosis and unnecessary prostate biopsies. Although PSA derivatives such as percentage free PSA and the Prostate Health Index (PHI) have improved diagnostic performance, substantial uncertainty persists, particularly in patients with equivocal magnetic resonance imaging (MRI) findings. Cancer-associated alterations in PSA glycosylation have emerged as a promising strategy to address these limitations. Percentage α2,3-linked sialylated PSA (S2,3PSA%) reflects tumor-associated glycoform changes that differ from those observed in benign prostatic conditions. This review summarizes the biological basis, analytical development, and clinical evidence supporting S2,3PSA% as a novel biomarker for prostate cancer diagnosis. We highlight key studies demonstrating that S2,3PSA% improves discrimination of clinically significant prostate cancer and provides complementary information when combined with PHI and MRI. Recent data further indicate that integrated diagnostic approaches incorporating S2,3PSA%, PHI, and PI-RADS scoring can meaningfully reduce unnecessary prostate biopsies without compromising detection of clinically significant disease. Beyond diagnostic accuracy, emerging evidence suggests that S2,3PSA%–guided risk stratification in screening settings may also reduce the number of unnecessary MRI examinations and biopsies, thereby contributing to more efficient use of healthcare resources and potential cost savings. We also discuss the potential role of S2,3PSA% in prostate cancer screening and active surveillance. Collectively, current evidence supports S2,3PSA% as a biologically informed biomarker that helps reduce diagnostic uncertainty inherent to PSA-based decision-making and facilitates more individualized and resource-conscious prostate cancer care.</p>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To explore clinicopathological risk factors associated with the development of castration-resistant prostate cancer (CRPC) in patients who underwent robot-assisted radical prostatectomy (RARP).
Methods
This study was conducted in nine Japanese institutions between 2012 and 2021. Patients with clinically metastatic PCa, those who received neoadjuvant or adjuvant therapy, were excluded. Consequently, 2825 patients with PCa were analyzed. Persistent prostate-specific antigen (PSA) was determined as a level ≥ 0.2 ng/mL at 1 month postoperatively and consistently in subsequent measurements.
Results
Median follow-up was 42.0 months. Under follow-up, 493 (17.4%) and 25 (0.8%) patients progressed to biochemical recurrence and CRPC, respectively. One hundred and ninety-six patients received salvage radiation therapy, and 229 patients received salvage androgen deprivation therapy. Among the 25 patients with CRPC, the median time to CRPC was 31.8 months. Univariate analysis revealed that preoperative PSA level, biopsy grade group (GG) 5, percentage of positive cancer cores, GG5 in RARP specimens, pT3b, pN1, positive surgical margins, lymphovascular invasion (LVI), and persistent PSA levels were associated with CRPC development. Multivariate analysis revealed that biopsy GG5 (adjusted hazard ratio [aHR] 12.74, p < 0.001), LVI (aHR 3.90, p = 0.011), and persistent PSA levels (aHR 8.66, p < 0.001) were independently associated with CRPC development. Furthermore, using these three factors made it possible to stratify CRPC-free survival among patients with PCa who received RARP and confirmed external validation.
Conclusions
The combination of biopsy GG5, LVI, and persistent PSA levels may stratify the risk of developing CRPC in patients with PCa undergoing RARP.
{"title":"Prognostic Factors of Castration-Resistant Prostate Cancer Among Patients With Localized Prostate Cancer Who Underwent Robot-Assisted Radical Prostatectomy in a Retrospective Multicenter Japanese Cohort (MSUG94)","authors":"Takeshi Sasaki, Atsushi Igarashi, Shin Ebara, Tomoyuki Tatenuma, Yoshinori Ikehata, Akinori Nakayama, Makoto Kawase, Masahiro Toide, Tatsuaki Yoneda, Kazushige Sakaguchi, Jun Teishima, Kazuhide Makiyama, Hiroshi Kitamura, Kazutaka Saito, Takuya Koie, Fumitaka Koga, Shinji Urakami, Toshinari Yamasaki, Takahiro Inoue","doi":"10.1111/iju.70370","DOIUrl":"10.1111/iju.70370","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore clinicopathological risk factors associated with the development of castration-resistant prostate cancer (CRPC) in patients who underwent robot-assisted radical prostatectomy (RARP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted in nine Japanese institutions between 2012 and 2021. Patients with clinically metastatic PCa, those who received neoadjuvant or adjuvant therapy, were excluded. Consequently, 2825 patients with PCa were analyzed. Persistent prostate-specific antigen (PSA) was determined as a level ≥ 0.2 ng/mL at 1 month postoperatively and consistently in subsequent measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median follow-up was 42.0 months. Under follow-up, 493 (17.4%) and 25 (0.8%) patients progressed to biochemical recurrence and CRPC, respectively. One hundred and ninety-six patients received salvage radiation therapy, and 229 patients received salvage androgen deprivation therapy. Among the 25 patients with CRPC, the median time to CRPC was 31.8 months. Univariate analysis revealed that preoperative PSA level, biopsy grade group (GG) 5, percentage of positive cancer cores, GG5 in RARP specimens, pT3b, pN1, positive surgical margins, lymphovascular invasion (LVI), and persistent PSA levels were associated with CRPC development. Multivariate analysis revealed that biopsy GG5 (adjusted hazard ratio [aHR] 12.74, <i>p</i> < 0.001), LVI (aHR 3.90, <i>p</i> = 0.011), and persistent PSA levels (aHR 8.66, <i>p</i> < 0.001) were independently associated with CRPC development. Furthermore, using these three factors made it possible to stratify CRPC-free survival among patients with PCa who received RARP and confirmed external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combination of biopsy GG5, LVI, and persistent PSA levels may stratify the risk of developing CRPC in patients with PCa undergoing RARP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To identify optimal candidates for Aquablation during the initial adoption phase by determining predictors of operative time and bladder irrigation volume to guide safe implementation.
Methods
We retrospectively analyzed 123 patients who underwent Aquablation between 2023 and 2025 during the initial implementation of this technique by Aquablation-naïve urologists at our institution. Patients with short operative times and low irrigation volumes were considered optimal candidates. Preoperative variables were assessed using multivariable linear regression. Because prostate volume (PV) demonstrated the strongest association with operative time and irrigation volume, post hoc exploratory locally estimated scatterplot smoothing (LOESS) analysis was performed to define a data-driven PV threshold, and perioperative outcomes were compared above and below this threshold.
Results
PV (median, 78 mL; interquartile range, 60–100 mL) was the only independent predictor of long operative times and great irrigation volumes. LOESS identified a PV threshold near 80 mL for bladder irrigation volume and 100 mL for operative time. Patients with PV < 100 mL had more favorable perioperative outcomes. Compared with PV ≥ 100 mL, PV < 100 mL had shorter operative times (median, 56 vs. 81 min; p < 0.05), lower irrigation volumes (median 9000 vs. 14 000 mL; p < 0.05), and smaller hemoglobin reductions (−0.9 vs. −1.6 mg/dL; p < 0.05); rates of Clavien-Dindo ≥ 3 adverse events, transfusion, and refulguration did not differ.
Conclusion
A PV < 100 mL appears to be a practical criterion for safe early adoption of Aquablation; accurate preoperative estimation of PV is therefore essential.
{"title":"Optimizing Patient Selection for Aquablation During the Initial Adoption Phase: Prostates Smaller Than 100 mL","authors":"Shin Koike, Yu Ozawa, Kei Ushijima, Keita Okamoto, Toshiaki Kayaba, Sunao Nohara, Masumi Yamada, Keisuke Aoki, Yu Odagaki, Hideo Sakamoto, Kunihiko Yoshioka","doi":"10.1111/iju.70373","DOIUrl":"10.1111/iju.70373","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To identify optimal candidates for Aquablation during the initial adoption phase by determining predictors of operative time and bladder irrigation volume to guide safe implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 123 patients who underwent Aquablation between 2023 and 2025 during the initial implementation of this technique by Aquablation-naïve urologists at our institution. Patients with short operative times and low irrigation volumes were considered optimal candidates. Preoperative variables were assessed using multivariable linear regression. Because prostate volume (PV) demonstrated the strongest association with operative time and irrigation volume, post hoc exploratory locally estimated scatterplot smoothing (LOESS) analysis was performed to define a data-driven PV threshold, and perioperative outcomes were compared above and below this threshold.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PV (median, 78 mL; interquartile range, 60–100 mL) was the only independent predictor of long operative times and great irrigation volumes. LOESS identified a PV threshold near 80 mL for bladder irrigation volume and 100 mL for operative time. Patients with PV < 100 mL had more favorable perioperative outcomes. Compared with PV ≥ 100 mL, PV < 100 mL had shorter operative times (median, 56 vs. 81 min; <i>p</i> < 0.05), lower irrigation volumes (median 9000 vs. 14 000 mL; <i>p</i> < 0.05), and smaller hemoglobin reductions (−0.9 vs. −1.6 mg/dL; <i>p</i> < 0.05); rates of Clavien-Dindo ≥ 3 adverse events, transfusion, and refulguration did not differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A PV < 100 mL appears to be a practical criterion for safe early adoption of Aquablation; accurate preoperative estimation of PV is therefore essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2025, the National Comprehensive Cancer Network (NCCN) updated the definition of very high-risk (VHR) prostate cancer to include individuals meeting at least two of the following: clinical stage ≥ T3, prostate-specific antigen ≥ 40 ng/mL, and Gleason Grade Group (GG) ≥ 4. This revision alters group classification and may impact surgical outcomes. We aimed to compare oncological outcomes under the earlier and 2025 definitions in individuals undergoing robot-assisted radical prostatectomy (RARP) without perioperative systemic therapy.
Methods
We retrospectively reviewed 1879 individuals who underwent RARP at two institutions between July 2012 and November 2022. Of these, 641 classified as high risk or above were analyzed: historical high risk (Group 1: n = 377), reclassified from VHR to high risk (Group 2: n = 119), and VHR per 2025 criteria (Group 3: n = 145).
Results
The median follow-up was 59.8 months. Five-year biochemical recurrence-free survival rates were 71.1%, 44.7%, and 29.8%; metastasis-free survival rates were 99.6%, 94.1%, and 88.9% for the three groups, respectively. Group 2 showed worse outcomes than Group 1. Exploratory analyses indicated that within Group 3, having > 4 biopsy cores with GG 4–5 was associated with significantly worse recurrence outcomes, whereas those without this factor had results closer to Group 2.
Conclusions
In conclusion, both the revised high-risk and VHR categories include heterogeneous populations. Refinement of risk stratification in the surgical setting may help identify subsets requiring tailored perioperative and multimodal strategies.
{"title":"Impact of the 2025 NCCN Definition Change for Very High-Risk Prostate Cancer on Surgical Outcomes After Robot-Assisted Radical Prostatectomy: A Retrospective Cohort","authors":"Noriyoshi Miura, Masaki Shimbo, Kensuke Shishido, Shota Nobumori, Naoya Sugihara, Takatora Sawada, Shunsuke Haga, Haruna Arai, Keigo Nishida, Osuke Arai, Tomoya Onishi, Ryuta Watanabe, Kenichi Nishimura, Tetsuya Fukumoto, Yuki Miyauchi, Tadahiko Kikugawa, Takato Nishino, Fumiyasu Endo, Kazunori Hattori, Takashi Saika","doi":"10.1111/iju.70366","DOIUrl":"10.1111/iju.70366","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In 2025, the National Comprehensive Cancer Network (NCCN) updated the definition of very high-risk (VHR) prostate cancer to include individuals meeting at least two of the following: clinical stage ≥ T3, prostate-specific antigen ≥ 40 ng/mL, and Gleason Grade Group (GG) ≥ 4. This revision alters group classification and may impact surgical outcomes. We aimed to compare oncological outcomes under the earlier and 2025 definitions in individuals undergoing robot-assisted radical prostatectomy (RARP) without perioperative systemic therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 1879 individuals who underwent RARP at two institutions between July 2012 and November 2022. Of these, 641 classified as high risk or above were analyzed: historical high risk (Group 1: <i>n</i> = 377), reclassified from VHR to high risk (Group 2: <i>n</i> = 119), and VHR per 2025 criteria (Group 3: <i>n</i> = 145).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up was 59.8 months. Five-year biochemical recurrence-free survival rates were 71.1%, 44.7%, and 29.8%; metastasis-free survival rates were 99.6%, 94.1%, and 88.9% for the three groups, respectively. Group 2 showed worse outcomes than Group 1. Exploratory analyses indicated that within Group 3, having > 4 biopsy cores with GG 4–5 was associated with significantly worse recurrence outcomes, whereas those without this factor had results closer to Group 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In conclusion, both the revised high-risk and VHR categories include heterogeneous populations. Refinement of risk stratification in the surgical setting may help identify subsets requiring tailored perioperative and multimodal strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary urethral carcinoma is an extremely rare malignancy, and evidence on its treatment and prognosis remains limited. This study aimed to clarify the treatment patterns, clinical outcomes, and prognostic factors for primary urethral carcinoma in Japan.
Methods
This retrospective study across 10 institutions included 57 Primary urethral carcinoma cases between 2004 and 2022. Recurrence-free survival and overall survival were estimated using the Kaplan–Meier method, and overall survival–related factors were evaluated using univariate Cox regression analysis.
Results
The cohort comprised 24 men (42%) and 33 women (58%), with a median tumor size of 30 mm (interquartile range, 15–48 mm). Stage distribution was ≤ I in 17 (30%), II in 10 (18%), III in 8 (14%), and IV in 21 (38%) patients. Urothelial carcinoma, including cases with divergent differentiation, was the predominant histological subtype, identified in 17 men (71%) and 14 women (42%). The median follow-up time was 17.1 months (interquartile range, 6.4–37.7 months). Overall survival did not differ significantly between Stage I and Stage II disease (p = 0.499), whereas it was significantly shorter in patients with Stage III and Stage IV disease compared with Stage I (p = 0.030 and p < 0.001, respectively). Previous urinary catheter placement, urethral diverticulum, and elevated lactate dehydrogenase (> 220 IU/L) were significantly associated with poorer overall survival.
Conclusions
Stage ≤ II Primary urethral carcinoma has favorable survival following definitive treatment, Stage III–IV disease showed poor outcomes, necessitating multimodal perioperative strategies (chemotherapy and/or radiotherapy).
{"title":"Clinical Outcomes and Clinicopathological Features of Primary Urethral Carcinoma: A Multicenter Retrospective Study in Japan","authors":"Keita Kobayashi, Kei Daizumoto, Takuya Tsujino, Ryoichi Maenosono, Minoru Kato, Taisuke Matsue, Shuichi Tatarano, Yohei Abe, Rikiya Taoka, Makito Miyake, Hideo Fukuhara, Kohei Ogawa, Kohei Kobatake, Yohei Sekino, Junya Furukawa, Hideki Enokida, Kiyohide Fujimoto, Keiji Inoue, Koichiro Wada, Koji Shiraishi, West Japan Uro-oncology Collaboration group","doi":"10.1111/iju.70367","DOIUrl":"10.1111/iju.70367","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Primary urethral carcinoma is an extremely rare malignancy, and evidence on its treatment and prognosis remains limited. This study aimed to clarify the treatment patterns, clinical outcomes, and prognostic factors for primary urethral carcinoma in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study across 10 institutions included 57 Primary urethral carcinoma cases between 2004 and 2022. Recurrence-free survival and overall survival were estimated using the Kaplan–Meier method, and overall survival–related factors were evaluated using univariate Cox regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort comprised 24 men (42%) and 33 women (58%), with a median tumor size of 30 mm (interquartile range, 15–48 mm). Stage distribution was ≤ I in 17 (30%), II in 10 (18%), III in 8 (14%), and IV in 21 (38%) patients. Urothelial carcinoma, including cases with divergent differentiation, was the predominant histological subtype, identified in 17 men (71%) and 14 women (42%). The median follow-up time was 17.1 months (interquartile range, 6.4–37.7 months). Overall survival did not differ significantly between Stage I and Stage II disease (<i>p</i> = 0.499), whereas it was significantly shorter in patients with Stage III and Stage IV disease compared with Stage I (<i>p</i> = 0.030 and <i>p</i> < 0.001, respectively). Previous urinary catheter placement, urethral diverticulum, and elevated lactate dehydrogenase (> 220 IU/L) were significantly associated with poorer overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stage ≤ II Primary urethral carcinoma has favorable survival following definitive treatment, Stage III–IV disease showed poor outcomes, necessitating multimodal perioperative strategies (chemotherapy and/or radiotherapy).</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treatment selection for metastatic castration-sensitive prostate cancer (mCSPC) remains challenging, as reliable and practical biomarkers predicting response to androgen receptor pathway inhibitor (ARPI)-based therapy are limited. We evaluated whether prostate-specific antigen (PSA) and Ki-67 expression in diagnostic biopsy specimens can predict oncologic outcomes in patients with mCSPC treated with ARPI–androgen deprivation therapy (ADT) doublet therapy, and whether these biomarkers can guide optimal treatment selection.
Methods
This retrospective multicenter study included 58 patients with mCSPC who received ARPI–ADT doublet therapy between 2018 and 2024. Immunohistochemical staining for PSA and Ki-67 was performed on diagnostic biopsy specimens. Receiver operating characteristic curve analyses were used to determine optimal cutoff values for predicting progression to castration-resistant prostate cancer (CRPC). Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Exploratory analyses included patients treated with triplet therapy (ADT + docetaxel + darolutamide) or upfront docetaxel.
Results
Low PSA expression, high Ki-67 expression, and a bone metastasis extent of disease (EOD) score ≥ 3 were independently associated with shorter CRPC-free survival (CRPC-FS). Stratification by risk factors (0, 1, or 2) showed a stepwise decline in CRPC-FS. In exploratory analyses, triplet therapy achieved the longest CRPC-FS and progression-free survival 2 among high-risk patients, whereas no significant differences among treatment modalities were observed in the low-risk group.
Conclusion
Immunohistochemical PSA and Ki-67 expression provide practical prognostic information for patients with metastatic castration-sensitive prostate cancer. Combined assessment with EOD ≥ 3 identifies a high-risk subgroup with unfavorable clinical outcomes.
{"title":"Impact of Immunohistochemical PSA and Ki-67 Expression on Prognosis in Metastatic Castration-Sensitive Prostate Cancer","authors":"Miyaka Umemori, Fumihiko Urabe, Yuya Iwamoto, Yu Imai, Kojiro Tashiro, Shun Sato, Hiroyuki Takahashi, Takahiro Kimura","doi":"10.1111/iju.70368","DOIUrl":"10.1111/iju.70368","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Treatment selection for metastatic castration-sensitive prostate cancer (mCSPC) remains challenging, as reliable and practical biomarkers predicting response to androgen receptor pathway inhibitor (ARPI)-based therapy are limited. We evaluated whether prostate-specific antigen (PSA) and Ki-67 expression in diagnostic biopsy specimens can predict oncologic outcomes in patients with mCSPC treated with ARPI–androgen deprivation therapy (ADT) doublet therapy, and whether these biomarkers can guide optimal treatment selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective multicenter study included 58 patients with mCSPC who received ARPI–ADT doublet therapy between 2018 and 2024. Immunohistochemical staining for PSA and Ki-67 was performed on diagnostic biopsy specimens. Receiver operating characteristic curve analyses were used to determine optimal cutoff values for predicting progression to castration-resistant prostate cancer (CRPC). Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Exploratory analyses included patients treated with triplet therapy (ADT + docetaxel + darolutamide) or upfront docetaxel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Low PSA expression, high Ki-67 expression, and a bone metastasis extent of disease (EOD) score ≥ 3 were independently associated with shorter CRPC-free survival (CRPC-FS). Stratification by risk factors (0, 1, or 2) showed a stepwise decline in CRPC-FS. In exploratory analyses, triplet therapy achieved the longest CRPC-FS and progression-free survival 2 among high-risk patients, whereas no significant differences among treatment modalities were observed in the low-risk group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Immunohistochemical PSA and Ki-67 expression provide practical prognostic information for patients with metastatic castration-sensitive prostate cancer. Combined assessment with EOD ≥ 3 identifies a high-risk subgroup with unfavorable clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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